Healthcare Provider Details

I. General information

NPI: 1861687170
Provider Name (Legal Business Name): KANDICE DIANNE SCHULTZ RN, ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/10/2007
Last Update Date: 12/11/2025
Certification Date: 12/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9040 REID ST
TACOMA WA
98431-1100
US

IV. Provider business mailing address

104 CRESTWOOD DR SW
LAKEWOOD WA
98498-3832
US

V. Phone/Fax

Practice location:
  • Phone: 253-968-2252
  • Fax: 253-968-3278
Mailing address:
  • Phone: 509-366-0361
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN 00165285
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberRN-0016525
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: